Personal and Spiritual Assessment Dan Fountain, MD, MPH

The importance of this  In medicine, the physical history and review of symptoms reveal the pathophysiology  The personal history reveals personal issues in the life of the person  We take a Spiritual history to understand our patient’s spiritual pathophysiology Do they believe their life is “making it?” Can they acknowledge it if they are not? What is their relationship with God?

An essential part of the history  Personal life issues affect health  They influence recovery from illness  We must find out about them  We must ask key questions  We must listen to the answers  We must process the answers – verbal and non-verbal – to discern the real problems

A routine part of the social history Do you smoke, drink? How much? Are you married? How long? Happily? What kind of work do you do? Any church or religious preference? These are non-threatening questions They are often on the computer intake form Look or listen for clues about problems

General questions How are things going in your life? At Work? At School? At Home? How are you coping with this illness? To whom can you go for help in time of need? (support systems)

Relationships  Are you having any trouble with your children?  Spouse? Or parents?  Co-worker? Or Boss?  Friends? Or other persons?  With someone of the opposite gender?  Are you really angry at someone?

Levels of Stress  What is your stress level?  Do you feel stressed out?  From what?  Do you feel anxious about anything?  Are you having difficulty concentrating?  How are you sleeping?  How is your appetite?  Any problems with finances or employment?

Recent loss  Have you recently lost a spouse, child, or close friend or relative?  Are you going through a separation of a divorce?  Have you lost your job, or feel you might do so?  Have you just retired? How is that going?

For a young person  How are things going in school?  Where are you heading in life?  What would you like to be?  Do you feel like you are not getting what you desire out of life?  Have you thought about who you really are?  If you should die, who would miss you?

Identify Patient’s Issues  LISTEN to what our patients are saying Fear, anxiety, gloom Anger, resentment, bitterness Guilt, shame, denial, self hatred, lonely Addictive behaviors, sabotaging self Self pity, hopelessness, passivity, loss of creativity  These are important personal issues  Helping a person cope with them is part of spiritual care

When a significant issue arises  Perhaps you can handle it quickly within your time constraints  You may want to refer the person to the spiritual caregiver on the team  It may require professional counseling help  Or you may give the person some “homework” (reflection) to do and then return for another visit

Make a record of findings and care  An abbreviated note about personal problems that will pass inspection but will help you recall the problem(s)  A similar note about your recommendations  On subsequent visits ask, “You mentioned… could you expound on that…?

Objections may arise  “Why are you asking me all these personal questions?”  “Do you think my problem is all in my head?”  A careful explanation of what medical science now knows about the affect and physiology can help  Proverbs 14 : 30 may help

A helpful response  These questions are so that I can understand you better and know how best to guide the treatment.  How we think and feel does affect the functioning of our heart and all of our organs and systems

Taking a spiritual history  First establish a level of trust  Proceed gently and go only as far as the person wishes us to go  Faith is of benefit to health and to recovery from illness  But imposition of our beliefs is unethical and must be avoided  Proselytism is not permissible

Opening questions  Tell me about your faith  Do you attend church? – temple, synagogue, etc.  Do you find that helpful?  Does your faith help you cope with life and with this illness?  Where do you feel God is in this?  Has you found help from him?

Church affiliation  Discussion of denominations is to be avoided  Find out if the church, or temple, provides support and help

A personal relationship with Christ  This is of positive benefit to health Sense of meaning, purpose, and destiny Peace of mind Joy in living  It is ethical to ask about this, but not to “push the issue”  Avoid “churchy” terminology

Explaining a personal relationship with Christ  God has created us for a relationship with him  Many of us prefer to “go it alone”  We resist knowing God and following him  He came to earth as Jesus, lived among us so that we could better understand God, and made it possible for us to live with God

Living with God now  We acknowledge our wrong-doing and our need for his help  We invite him to live within our spirit and show us how to live  Daily communication with him  Trust in his goodness and power to help us

Guiding Principles  Proselytism must be avoided  If the person is not interested or is resistant to the Christian Faith, keep an open caring relationship, but do not push Christianity  Interest may develop later  The word ‘sin’ may be offensive  If so, talk about ‘regrets’

Discussion of Faith should only come after  A relationship of openness and honesty has been established  The sick person has described the illness or problem for which they are there  We have demonstrated an interest in them

If appropriate, share your own spiitual story  Your story is yours. It is not an argument or an effort to persuade  Usually somewhere along the line there is an identification  It makes you more real to the one with whom you are speaking  “Would you like to hear how God has helped me?”

Making A Spiritual Diagnosis  From your conversations, certain spiritual needs emerge What is the sick person’s self image? Does she have joy, peace, and hope? How is he coping with the consequences of the illness? Where does she find help in time of need? Does he have a relationship with the Lord? Once you identify a spiritual need, confer with your consultant, the Holy Spirit, and follow His lead

Be Careful…  Do not ask too many questions at once  This is not an inquisition  The goal is healing  Ask only those questions that move toward this goal

As Christian Care Givers…  We need to confront their spiritual health as well as their physical health  Explain if asked why we are bringing “that” up, that you care about them, and recognize it impacts their health

Confronting  We tell patients truths, because they need to hear them  We earn the right to confront when the patient knows they are loved, accepted, valued and understood  As clinicians we have the moral obligation to identify destructive factors in patient’s lives Are there other things going on in your life that may be contributing to your problem? I’m really concerned that unless you deal with…it may impact your overall health  These may be physical, emotional, or spiritual issues

Church attendance  Attending a good church is beneficial  Encourage regular attendance  Learn about the churches in your area  Many people do not attend church so may not be comfortable at first  In this case, offer to take them to your church for the first time to introduce them to “church culture”

The Gospel  The power of God for salvation of all who believe  Salvation (Yeshua) includes health and wholeness

Remember :  Spiritual care has a solid base of evidence  It must be patient directed  It can bring new life  It can bring healing of heart, soul, and spirit and, in many cases, of the body